Public Health Expands for New Role

Terrorism, Anthrax Draws Attention to Public Health

Since the terrorist attacks on Sept. 11, 2001 and the anthrax scare months later, the Fairfax County Department of Health has been cast in a new role of sorts, as a first responder in the event of a public-health emergency and the new acting director, Dr. Gloria Addo-Ayensu likes it that way.

"The anthrax crisis just changed the face of public health. It put us in a role the health department had never been in before. The health department had never been considered a first responder along with fire and police and we are," Addo-Ayensu said. "We were doing such a good job with public health, things dropped of the radar screen. It began with county funding. We were left with the bare bones. The events of the last year and a half have made people realize how important this agency is. Our work is so subtle. We save lives everyday. We do heroic things, but it's not out there getting attention. Even though the attention is on us now, we're going and doing business as usual."

ADDO-AYENSU BEGAN her career with the county health department as a clinician and medical director for the Mount Vernon District Office in November 1999. In October of 2001, she became an assistant health director overseeing the agency’s emergency preparedness and communicable diseases programs. In March, Addo-Ayensu took over as acting director of the agency.

"She's a very participatory health director. She gets in there and works the issues," said Michelle Bachus, assistant director for patient care services, communicable diseases and bioterrorism. "She attends a good deal of meetings and provides input, which helps her understand what is going on in the community. She makes a decision with a good deal of knowledge."

Some of the decisions she has been making include the continued restructuring of the department, which began when she became assistant director. And all of her decisions, she said, are made after consulting with a team of assistants.

"I work very well in teams and the support is there, which is the best way to go," Addo-Ayensu said. "Think of it as if you have a circle. The integrity of the circle depends on you. You don't want to let the others in the circle down. When we have success, we all share the success. When we have failure, we all have failure."

Part of that restructuring has included a focus on creating specialists when it comes to the public-health nurses. That means instead of having cases that run the gamut — the department's five clinics do everything from refugee screenings, providing services for pregnant women, education and treatment of communicable diseases and inoculating international travelers — the public-health nurses will have certain areas to concentrate on.

THE DEPARTMENT NOW has three communicable disease nurses, who handle investigations, eight nurses dedicated to tuberculosis, and a couple of nurses to handle food-borne diseases with the environmental health side of the agency. Moreover, Addo-Ayensu has recently hired a pulmonologist to work 30 hours per week solely for the tuberculosis program. In addition, there is now a tuberculosis coordinator.

The department has also recently hired an endocrinologist and an emergency planner, formerly known as a bioterrorism coordinator. Both positions are part of the state emergency plan and are funded through grants from the Centers for Disease Control and Prevention (CDC) and the state. Addo-Ayensu also hopes to hire an entomologist for the environmental health team to help with insect-borne diseases such as West Nile virus and malaria.

"The reorganization is part of us trying to be as efficient as possible," Addo-Ayensu said. "It's possible to keep up with all the services we provide because we have a bunch of dedicated people who are doing more with less. People understand we're in a different world and maybe that gets manifested on my watch."

ALL OF THE ATTENTION focused on the department surrounds emergency preparedness, but Addo-Ayensu does not want people to lose sight of the other things such as educational and treatment programs for sexually transmitted diseases, prenatal care, AIDs, tuberculosis, syphilis, West Nile virus malaria and now SARs, or severe acute respiratory syndrome, recently discovered lung disease that first appeared in parts of Asia. In addition, the environmental health team is involved in educating the public about diseases such as West Nile virus, while also performing inspections on restaurants, wells and pools. The department's laboratory processes specimens not only for the department, but also for private physicians and serves as an educational source for doctors and hospitals when alerts and new guidelines come from the CDC.

As far as emergency preparedness goes, the department still has some work to do. It has recently started vaccinating volunteers against the smallpox virus, has put into place the basic foundation of an emergency response plan and has been in contact with other jurisdictions to make sure if something were to happened, the response would be a coordinated effort.

"We're still in the midst of down-in-the-weeds planning, but we're in a better position to respond than say during the anthrax crisis," said Steve Church, the county's emergency planner. "Everyone's been trained to an extent. We have done a lot to put our plan in place. Say, for example, we have to do mass vaccinations or a mass medicine distribution, we have numbers of volunteers and all their contact information. We have identified team leaders, about 100 of them, and have a work force of several thousand, medical and nonmedical personnel, to plug into clinics."

Bachus said the transition to a more bioterrorism-focused department has not been easy given the department's limited number of staff. According to a press release from the county’s public affairs office, the department has a budget of approximately $38 million and a 555-member staff.

"Public health has historically been quiet and it's good when it's quiet because it means we're doing our job," Bachus said. "So come budget time, we tend to lose out. Now with bioterrorism, we've kind of risen to the top and we are seeing a change."

ADDO-AYENSU, originally from Ghana, earned her medical degree from Tulane University School of Medicine in New Orleans, La., in 1994 after receiving a master's degree in public health in international health from Tulane School of Public Health in 1989. She completed her residency in clinical preventative medicine at Loma Linda University Medical Center in California. Afterwards, she joined the facility at the university from 1996-99.

"Coming from a country like Ghana, where even if you have the resources to buy equipment, people still don’t have the money to receive the medical care, the only thing that makes sense is preventive medicine," Addo-Ayensu said. "It quickly became clear to me in medical school, because I always had an interest in going back home, preventive medicine makes me more useful. Even in the U.S., it makes sense."

Since entering medical school, Addo-Ayensu has been involved in research projects in Ghana and has taken some county public-health nurses back with her on medical missions.